Form Nc-4ez - Employee'S Withholdingallowance Certificate - 2014
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1NC-4EZ
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Employee’s Withholding
12-14
Allowance Certificate
Social Security Number
Marital Status
_________ - ______ - _________
______ Single _______ Head of Household
_______ Married or Qualifying Widow(er)
First Name
M.I.
Last Name
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
_________________________________________________
_____
__________________________________________________
Address
County
(Enter first five letters)
_____________________________________________________________________________________________
_________________
City
State
Zip Code
Country
(5 Digit)
(If not U.S.)
__________________________________________________
____________
_____________
______________________
FORM NC-4EZ: Please use this form if you:
-Plan to claim the N.C. standard deduction
-Plan to claim no tax credits or only the credit for children
-Prefer not to complete the extended Form NC-4
-Qualify to claim exempt status (See lines 3 or 4 below)
Important: If you are a nonresident alien you must use form NC-4 NRA.
You may complete Form NC-4, if you plan to claim N.C. itemized deductions, federal adjustments to income, or N.C. deductions.
If you do not plan to claim the credit for children, enter zero (0) on line 1. If you plan to claim the credit for children, use the table below for your filing status,
amount of income, and number of children under age 17 to determine the number of allowances to enter on line 1. For married taxpayers, only 1 spouse m ay
claim the allowance for the credit for each child.
Single & Married Filing Separately
Married Filing Jointly & Qualifying Widow(er)
Head of Household
Income
# of Children Under age 17
Income
# of Children Under age 17
Income
# of Children Under age 17
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10
# of Allowances
# of Allowances
# of Allowances
0 1 2 3 4 5 6 6 7 8
0 1 2 3 4 5 6 6 7 8
0 1 2 3 4 5 6 7 8
0-40,000
0-32,000
0-20,000
0 1 2 3 4 5 6 7 8
0 1 2 3 4 5 6 6 7 8
0 1 2 3 4 5 6 6 7 8
0-40,000
0-20,000
0-32,000
1. Total number of allowances you are claiming (Enter zero (0), or the number of allowances from the table above)
_________
2. Additional amount, if any, withheld from each pay period (Enter whole dollars)
.00
_____________________
3. I certify that I am exempt from North Carolina withholding because I meet both of the following conditions:
• Last year I was entitled to a refund of all State income tax withheld because I had no tax liability; and
Check Here
• This year, I expect a refund of all State income tax withheld because I expect to have no tax liability
4. I certify that I am exempt from North Carolina withholding because I meet the requirements Check Here
of the Military Spouses Residency Relief Act and I am legally domiciled in the state of
(Enter state of Domicile) ______ Check Here
If line 3 or line 4 above applies to you, enter the effective year 20 _____
5. I certify that I no longer meet the requirements for exemption on line 3
or line 4
(Check applicable box)
Therefore, I revoke my exemption and request that my employer withhold North Carolina income tax based on the
Check Here
number of allowances entered on line 1 and any amount entered on line 2.
CAUTION: If you furnish an employer with an Employee’s Withholding Allowance Certificate that contains information which has no
reasonable basis and results in a lesser amount of tax being withheld than would have been withheld had you furnished reasonable
information, you are subject to a penalty of 50% of the amount not properly withheld.
_________________________________________________________
______________
Employee’s Signature
Date
I certify, under penalties provided by law, that I am entitled to the number of withholding allowances claimed on line 1 above,
or if claiming exemption from withholding, that I am entitled to claim the exempt status on line 3 or 4, whichever applies.
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